Health in the Free state

A province that is in the news for all the wrong reasons. Spotlight keeps the focus on this beleaguered province and the right to health care as provided by the State. Some good news, some bad news and some downright ugly news. The spotlight has to remain on this province.

The good

Good news is that it’s an election year. Road works are everywhere and, irritating as they may be to endure sometimes, they signal investment in much-needed infrastructure.

The same can be said of upgrades and refurbishments at some clinics and hospitals. Sections of Pelonomi Regional Hospital look swish and modern and ready for action, and the once dilapidated Batho Clinic on the outskirts of Bloemfontein is undergoing a revamp.

More good news has come in the form of ground-up initiatives.

Projects like the ARV Adherence Clubs, managed by MosaMaria, have managed to divert 11 000 HIV-positive people out of hospital queues in under two years. This has relieved queue congestion at hospitals and clinics but has also, importantly, introduced better monitoring and tracking to help keep patients from defaulting.

Perhaps the best of the good news is an acknowledgment from Premier Ace Magashule, in a meeting this May with the TAC, that civil society structures and government need to meet more often, need to understand one other better, and need to find common ground to heal a broken healthcare system in the province.

The meeting was a public dressing down of Health MEC Benny Malakoane, with Magashule chastising Malakoane for failing for five years to meet with the TAC. The meeting was also a call from government for greater cooperation and less personalisation in the fight for a transformed healthcare system and for the members of his executive committee to do better.

This is plain speaking from an official of rank. If his sentiments are true, it is a positive step towards undoing the bad and the ugly that’s perniciously pervasive in the province.

The bad

The bad and the ugly in the Free State have been debilitating.

The provincial government has steadfastly denied that it rules over a crumbled health-care system, including the failed NHI pilot district of Thabo Mofutsanyana. There has been a lack of transparency, bureaucracy has been used as a device of obfuscation, and there’s been very real intimidation of those who dare challenge Health MEC Benny Malakoane.

All of this has only served to deflect from the work that still needs to be done in the Free State and the reality that the real casualties are counted in lives lost.

The ugly

Tyranny is an insidious disease that spreads from top structures to those who mimic Malakoane’s style of leading by intimidation, denial and deflection. It filters down to regional heads who won’t engage and nurses who are rude with impunity.

The flip side of tyranny is intimidation and fear. There are those who loathe Malakoane but feel they need to protect their identities because their jobs may be on the line. They speak out only on condition of anonymity.

Throughout the province residents, activists, nursing staff and community workers are speaking out more and more about the change that must come. They want a health-systems overhaul that will ensure proper capacity in their facilities, excellent management and respect and dignity for the thousands who rely on public health care in the province.

Where hope lies

There must be an end to working in silos for infrastructure not to be reduced to hollow buildings filled with equipment that no one ever uses. This is true of Pelonomi Hospital and Batho Clinic.

True too, of the Trompsburg Hospital, which was scheduled to be opened in October 2014 and is now only scheduled to open in July this year. The build never made budget and there remains a funding deficit to buy equipment and hire staff.

It’s only sensible that an integrated approach, one that factors in infrastructure development, proper equipment and maintenance, and staffing. Only a long-term vision can attract and retain staff in the public health sector and grow confidence among those who rely on the services.

Clearly the Free State has not broken free of its chains just yet. Reports still circulate, like the ones from Netwerk24 of no single gynaecologist or any specialist staff to oversee the more than 4 800 births that take place at Pelonomi Hospital. Vacant positions have simply remained unfilled, although the department says there’s been no “hiring freeze”.

There’s also the report by GroundUp of the #HireANurse Twitter campaign launched in May this year as desperate, qualified nurses (an estimated 250 of them), cannot get work in the province.

There’s also the matter of the still-unanswered questions by opposition parties, residents – and even matrons and doctors – over the tender process of Buthelezi Emergency Medical Services in the Free State and about whether they are fit to operate as per their contract.

More lingering bad and ugly news is that Malakoane, along with seven other Free State officials, is still to answer to charges of accepting bribes, fraud and corruption. The amount in question is believed to be around the R20-million mark and charges date back to between 2007 and 2009. Malakoane was municipal manager of the Matjhabeng municipality at the time.

Malakoane’s punitive and petty management style also means that 94 community health workers still face court action for being part of a “prohibited gathering” when they held a peaceful candlelight protest at the Department of Health’s Bophelo House in Bloemfontein in July 2014.

All this while the province’s health department remains under administration, with National Treasury still overseeing the budgets for the department.

There has to be a new story to tell for the Free State. Whether it’s a story of turnaround rather than gloom is up to the government.

Activists, meanwhile, will keep up the pressure: residents and locals still need to be heard. They still need to be the central voice in the next chapter of the Free State health services story.

 

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